One-year mortality of HIV-positive patients treated for rifampicin- and isoniazid-susceptible tuberculosis in Eastern Europe, Western Europe, and Latin America

Abstract

Objectives: The high mortality among HIV/tuberculosis (TB) coinfected patients in Eastern Europe is partly explained by the high prevalence of drug-resistant TB. It remains unclear whether outcomes of HIV/TB patients with rifampicin/isoniazid-susceptible TB in Eastern Europe differ from those in Western Europe or Latin America.

Methods: One-year mortality of HIV-positive patients with rifampicin/isoniazid-susceptible TB in Eastern Europe, Western Europe, and Latin America was analysed and compared in a prospective observational cohort study. Factors associated with death were analysed using Cox regression modelsRESULTS:: Three hundred and forty-one patients were included (Eastern Europe 127, Western Europe 165, Latin America 49). Proportions of patients with disseminated TB (50, 58, 59%) and initiating rifampicin + isoniazid + pyrazinamide-based treatment (93, 94, 94%) were similar in Eastern Europe, Western Europe, and Latin America respectively, whereas receipt of antiretroviral therapy at baseline and after 12 months was lower in Eastern Europe (17, 39, 39%, and 69, 94, 89%). The 1-year probability of death was 16% (95% confidence interval 11-24%) in Eastern Europe, vs. 4% (2-9%) in Western Europe and 9% (3-21%) in Latin America; P < 0.0001. After adjustment for IDU, CD4 cell count and receipt of antiretroviral therapy, those residing in Eastern Europe were at nearly 3-fold increased risk of death compared with those in Western Europe/Latin America (aHR 2.79 (1.15-6.76); P = 0.023).

Conclusions: Despite comparable use of recommended anti-TB treatment, mortality of patients with rifampicin/isoniazid-susceptible TB remained higher in Eastern Europe when compared with Western Europe/Latin America. The high mortality in Eastern Europe was only partially explained by IDU, use of ART and CD4 cell count. These results call for improvement of care for TB/HIV patients in Eastern Europe.

Fig. 1.. Flow chart of TB:HIV Study patients with rifampicin and isoniazid-susceptible tuberculosis included in the analyses.

TB, tuberculosis.

Fig. 2.. Use of ART, HIV RNA and CD4⁺ cell count status in 341 HIV patients with drug-susceptible tuberculosis during 12 months after initiation of anti-TB therapy.

Eastern Europe (Belarus, Estonia, Georgia, Latvia, Lithuania, Poland, Romania, Ukraine, Russia); Western Europe (Belgium, Denmark, France, Italy, Spain, Switzerland, United Kingdom); Latin America (Argentina, Chile, and Mexico).

Fig. 3.. Probability of death among 341 HIV patients with rifampicin and isoniazid-susceptible tuberculosis according to their region of residence.

Number of deaths: 20 in EE, 7 in WE and 4 in LA. EE, Eastern Europe (Belarus, Estonia, Georgia, Latvia, Lithuania, Poland, Romania, Ukraine, Russia); LA, Latin America (Argentina, Chile, and Mexico); TB, tuberculosis; WE, Western Europe (Belgium, Denmark, France, Italy, Spain, Switzerland, United Kingdom).

Fig. 4.. Cox proportional hazard model of factors associated with 31 deaths in 341 HIV patients with rifampicin- and isoniazid-susceptible tuberculosis.

ART, antiretroviral therapy; EE, Eastern Europe (Belarus, Estonia, Georgia, Latvia, Lithuania, Poland, Romania, Ukraine, Russia); HR, hazard ratio; CI, confidence interval; IDU, injecting drug use; LA, Latin America (Argentina, Chile, and Mexico); WE, Western Europe (Belgium, Denmark, France, Italy, Spain, Switzerland, United Kingdom); CD4⁺ cell count measurement (cells/mm³)